This post is in response to a question from Canadian reader Beth, who wants to know more about the barriers that stand in the way of her daughter (who has a chronic health condition) receiving patient-centered, integrated care.
Integrated care and patient-centered care are two terms that convey a lot of potential and promise for the parents of children with chronic health conditions, however, the health care system is experiencing growing pains in order to achieve them. Before we go on, it’s important to discuss what these terms mean.
Patient-Centered Care: This is the practice wherein the patient and their families are viewed as equal partners in the medical decision making process with the physician remaining the lead clinical partner. The Canadian Medical Association (CMA) first committed to encouraging patient-centered care in 2007.
Integrated Care: When care is fully integrated, health care services are coordinated across specialties and across aspects of the patient’s life, including at home and in the community. You can find out more about integrated care from a working paper the CMA co-authored with the Canadian Nurses Association here.
In an integrated health care environment, services can be precisely targeted to individual patient needs, and delivered by the most appropriate provider, in the most appropriate environment, at just the right time.
However, achieving integrated care is a much more complex task than many suspect, and it’s a task that health care systems across the globe are struggling to achieve.
There are two main issues that prevent truly integrated care in Canada:
- Our health care system still has ‘silos.’ These silos can include general practitioners, specialists and hospitalists, all areas of the health care system that a child with a chronic health condition may encounter. When one silo can’t or struggles to talk to another it complicates care for the patient as they are dealing with more than one silo. This is an issue we recognize and a driving force for innovation. There are examples of excellence in breaking down silos within the Canadian health care system, but complete nation-wide system reform will take time.The CMA has defined “Medical Professionalism” as a strategic priority for 2015-2017.One dimension which we will be exploring in greater detail is patient centred care. PCC is a buzz word these days that means different things to different people and we want to better understand this term both from the perspective of the physicians but also the public, and from there, define an opportunity to close the gap – – – all with the overarching intention to improve quality of care and patient outcomes. CMA will be travelling across the country, reaching out to patients and the public beginning in fall 2016 on this topic. Watch ca/gooddoctors for more information as it becomes available.
- The other issue is the state of our Electronic Medical Record (EMR) system. Technology can help us innovate solutions to health care problems, but it can also create problems. Connectivity between systems, often within a region or province, may not exist yet. A good analogy for this issue are the smartphones almost all of us use. Let’s say you have an iPhone and want to send your friend, who uses an Android device, a message using an app that’s only available on iPhone. Your friend won’t be able to receive the message because the app doesn’t exist on his smartphone. The same thing is happening in health care with EMRs. Working to get the EMRs in every hospital and doctor’s office across Canada to talk to each other will take years, but it is a vision we’re actively working towards.
Going back to the app analogy we often hear, “If the banks can provide me with online banking, mobile apps, and timely service, why can’t health care?” It’s a good question, and all of us would love nothing more than an app on our phone that would allow us to see our child’s most recent medical information and confirm that it’s been shared with the right providers. But health care is a little different from banking.
Imagine if you knew you needed a financial service, but you didn’t know which one. So you walk into any bank – not necessarily your bank, but any bank in Canada, based on who was closest when you needed the service. In order to determine which financial service you needed your banker would have to look at all of your financial information – not just recent transactions, but your complete financial history, and your family’s financial history – to figure out which financial service you needed.
Most of us know what financial service we need when we walk into a bank or open up a banking app; we know we want to transfer money, make a deposit or open up a new account. When we see a health care provider we often don’t know what service we need, we just know that there’s a problem. This is especially true with children, who often can’t articulate exactly what’s wrong.
Because the scope of complex health care system issues are so broad they are often beyond the promise of mobile technologies to solve completely. They can be a part of the solution, of course. We’re on our way to achieving the vision of precise, integrated care, but we need to keep working at it diligently and with patient input.
Unfortunately for many parents of children with chronic health conditions this leaves them playing the role of facilitator or care advocate for their children. This is frustrating, especially as managing the care of a child with a chronic health condition can be a full-time job. At the CMA we understand this frustration as most of us are parents as well, and physicians especially understand as they would like nothing more than to spend less time tracking down test results and coordinating care and more time actually delivering care to their patients. We may be years from truly integrated care, but we’re all working in the same direction to get us there.